This career development award supports the development of Joanne Wood, MD, MSHP as an independent researcher focusing on child maltreatment research and improving the quality of care for victims of abuse. Through the K23 award, Dr. Wood will gain advanced training in health services research and expand her skills to include qualitative research methods. Career development goals outlined in the application will serve as the basis for future investigations in the field of child maltreatment, including healthcae quality and outcomes research and quality benchmarking. Dr. Wood proposes a comprehensive research program that will serve as the foundation for future work in health services research and child maltreatment. Dr. Wood aims to develop, validate, and apply quality metrics for occult injury screening, a crucial component of the evaluation for suspected physical abuse in young children. Aim 1 will develop and validate appropriateness criteria for radiographic screening for occult injuries in young injured children. Aim 2 will construct and validate a set of algorithms for assessing the appropriateness of screening for occult injuries that can be applied to administrative data. Aim 3 will compare the quality of screening practices for occult injuries across pediatric hospitals. Aim 4 will identify factors that promote appropriat use, overuse, and underuse of screening. Her approach to address limitations in recognizing and diagnosing abuse involves the use of quantitative and qualitative methods. Dr. Wood is a junior investigator with training in health policy research and extensive experience in pediatrics and child abuse pediatrics at a large, urban children's hospital. She has assembled an outstanding multidisciplinary team of mentors led by David Rubin, MD, MSCE (primary mentor) and Chris Feudtner, MD, PhD, MPH (co-mentor) to guide her career development. Her program will include formal didactics and practical experience gained through conduct of original research using both quantitative and qualitative methods. Dr. Wood will enhance the quality of her work and future contributions to the field through the mentoring, advanced training, and supervised research experience set forth in her K23 proposal. The Children's Hospital of Philadelphia and University of Pennsylvania offer outstanding resources and mentorship that will enable Dr. Wood to develop her long-term goals. Her affiliations and familiarity with the many departments and institutes will provide access to researchers across the health system and across the University. Serving as a supportive environment, the Division of General Pediatrics, the Department of Pediatrics, and the Hospital are committed to advance her research career. PUBLIC HEALTH RELEVANCE: Occult injury screening in young children who present with injuries has been recognized as an important set of tests that can aid clinicians in diagnosing abusive injuries, which is critical to the safety and wellbeing of these children. Disparities and variation in the utilization of occult injury screening at pediatric hospitals, however, exist due o lack of clear criteria regarding the appropriate use of occult injury screening. This proposal aims to establish and evaluate criteria for appropriate use of occult injury screening, to develop and evaluate quality metrics for assessing occult injury screening practices in hospitals, and to use those metrics to assess hospital performance.